Provider Demographics
NPI:1174068472
Name:RECIO, YESSICA (LPN)
Entity type:Individual
Prefix:
First Name:YESSICA
Middle Name:
Last Name:RECIO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:YESSICA
Other - Middle Name:
Other - Last Name:EJSMENTEWICZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:490 AMSTERDAM AVE
Mailing Address - Street 2:APT.3N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4654
Mailing Address - Country:US
Mailing Address - Phone:646-841-6509
Mailing Address - Fax:
Practice Address - Street 1:490 AMSTERDAM AVE
Practice Address - Street 2:APT.3N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4654
Practice Address - Country:US
Practice Address - Phone:646-841-6509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303872-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse